The relationship between morphological lesion, magnetic source imaging, and intracranial stereo-electroencephalography in focal cortical dysplasia

Magnetoencephalography (MEG) is a useful non-invasive technique for presurgical evaluation of focal cortical dysplasia patients. We aimed at clarifying the precise spatial relationship between the spiking volume determined with MEG, the seizure onset zone and the lesional volume in patients with focal cortical dysplasia. We studied the spatial relationships between the MEG spiking volume determined with a recent analysis pipeline, the seizure-onset zone location determined with a quantitative index calculated from intracranial EEG signals ('Epileptogenicity Index') and the lesional volume delineated on brain MRI in 11 patients with Focal Cortical Dysplasia explored with Stereo-electroencephalography (SEEG). A significant correlation between the MEG spiking activity and the Epileptogenicity Index was found in 8/11 patients. 7/8 patients were operated upon and had good surgical outcome. For three patients, no correlation between Epileptogenicity Index and spiking activity was observed; only one of those three patients had good surgical outcome. The lesion was at least partially overlapping with the seizure-onset zone in 8/9 patients with a lesion clearly identifiable by MRI. However, 57% of the SEEG epileptogenic contacts were located outside of the lesional volume. Lastly 44% of the highly epileptogenic SEEG contacts were located within the spiking volume and 22% of them were located exclusively in the spiking volume and not in the lesion. For 7/9 patients with a lesion,< 50% of epileptogenic SEEG contacts were included within the lesion: for 5/7 patients MEG provided an added value for targeting the epileptogenic region through intracranial electrodes, while for two of seven patients MEG detected only a few extralesional epileptogenic contacts. Our study suggests that modeling of the spiking volume with MEG is a promising tool to localize noninvasively the seizure-onset zone in patients with focal cortical dysplasia. Combined with brain MRI, MEG modeling of the spiking volume contributes to delineate the spatial extent of the seizure-onset zone.